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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202784
Report Date: 10/05/2021
Date Signed: 10/05/2021 03:53:49 PM

Document Has Been Signed on 10/05/2021 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:OAKFIELD MANOR LLCFACILITY NUMBER:
435202784
ADMINISTRATOR:CASIM, ELVIRAFACILITY TYPE:
735
ADDRESS:145 NORTH GADSDEN DRIVETELEPHONE:
(408) 945-9197
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 6CENSUS: 0DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Ricardo ClutarioTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Ricardo Clutario.

LPA Marrufo observed that there were no residents present in the facility.

LPA toured the kitchen area, dinning area, hallways, 3 out of 3 resident bedrooms, outside area, and garage. LPA observed COVID-19 related posters posted throughout the hallways and bathrooms. LPA Marrufo observed there to be a visitor screening area at the entrance. The facility maintains a 30-day supply of PPEs.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Ricardo Clutario and a copy of the report was provided.
SUPERVISORS NAME: Jackie Jin
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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